An anal fissure which does not heal with conservative measures as sits baths and laxatives is a chronic anal fissure. Physiologically, it is the high resting tone of the internal anal sphincter that chiefly interferes with the healing process of these fissures. Until now, the gold standard treatment modality is surgery, either digital anal dilatation or lateral sphincterotomy. However, concerns have been raised about the incidence of faecal incontinence after surgery. Therefore, pharmacological means to treat chronic anal fissures have been explored.A Medline and pub med database search from 1986-2012 was conducted to perform a literature search for articles relating to the non-surgical treatment of chronic anal fissure.Pharmacological sphincterotomy using Glyceryl trinitrate , Isosorbide dinitrate or calcium channel blockers are exciting alternative treatment , that relaxes the anal sphincter and, therefore, promote healing, the drawback of such medications are headache and poor compliance. With the introduction of Botulinum toxin as mean of chemical sphincterotom, topical injection of Botulinum toxin reduces the anal hypertonia which lasts for few months, allows the fissure to heal, thus eliminating the need for surgery without incidence of incontinence. Cure rates are over 60%, and the procedure can be repeated safely. Therefore, Botulinum toxin is a reasonable first-line management of chronic anal fissure and the relapses can be managed by surgeryKeywords: Non-surgical treatment of anal fissure, fissure in ano, sphicterotomy,botulinum toxin in anal fissures, glyceryl trinitrate. Chemical sphincteratomy, pharmacological sphincteratomy.
A simple, economic, rapid, reliable, and stability-indicating high-performance liquid chromatography (HPLC) method has been developed and validated for the simultaneous determination of paracetamol (PCM) and caffeine (CF) in solid dosage form. The chromatographic separations were achieved with a Waters Symmetry® C18 column (5 μm, 4.6 × 150 mm), using a mixture of methanol and water (40:60, v/v) as a mobile phase, under isocratic elution mode with a flow rate of 0.8 mL/min, and ultraviolet (UV) detection was set at 264 nm. The oven temperature for the column was set and maintained at 35 °C. The method was validated according to International Conference on Harmonization (ICH) guidelines, and it demonstrated excellent linearity, wi
... Show Moreresearch aim :
- The research aimed to investigate the effect of two treatment
methods in the gaining of fourth grade students in geography
object.
- Research hypothesis
there are no statistically significant differences at the level of ( 0.05 )
in the average level of achievement in geography between the first
experimental group ( strengthening lessons ) and the second group
( re- teaching )
no individual differences statically significant at the level of ( 0.05 )
in the average level achievement in geography object of the second
experimental group ( re- teaching ) and the first experimental group
( strengthening lesson )
the research sample : the researcher selected randomly Baghdad
The present study discusses the significant role of the historical memory in all the Spanish society aspects of life. When a novelist takes the role and puts on the mask of one of the novel’s protagonists or hidden characters, his memory of the events becomes the keywords of accessing the close-knit fabric of society and sheds lights on deteriorating social conceptions in a backwards social reality that rejects all new progressive ideas and modernity. Through concentrating on the society flawing aspects and employing everything of his stored memory, the author uses sarcasm to criticize and change such old deteriorating reality conceptions.
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... Show MoreThis research aims to identify the role that forensic accounting plays on the transparency and quality of the financial statements in trade bank of Iraq and the Gulf Commercial Bank in Babylon. This research came to address the problem that most financial institutions suffer from, which is represented by the lack of transparency and the quality of the financial statements issued in a manner. Annual also the manipulation and fraud in the financial data, which causes a big gap between that institutions and organizational stakeholders. According to the implementation of the research hypothesis and the objectives of the research, a questionnaire was prepared consisting of three axes, the first axis dealing with the demographic distri
... Show MoreStandards play a vital role in documenting the values of new test results in the form of tables. They are one of the basic requirements that the standardization process aims for as a complement to standardizing test procedures, and contribute to knowing the current reality of the student. The degree of readiness and level as a result of practicing different exercises for sports activities, in addition to the possibility of adopting it for comparison with his group or similar groups, classification, prediction and selection. Developing the skill of handling the football in the educational field is an important matter for achieving distinguished performance among students. This skill requires a level of accuracy, speed and control, and
... Show MoreA literary-educational work is a work that explains wisdom to the reader and presents moral, educational and instructional issues in a literary form. Qaboos-nameh or Nasihat al-Muluk is an educational and educational book that has a special place in the field of ethics and guidance, where the author guides his children. Also, Ibn al-Wardi's Lamiyah or Nasihat al-Akhwan is a poem containing moral advice and advice in 77 verses that Ibn al-Wardi wrote to his son.
It seems that the main goal of Ibn al-Wardi and Onsur AL-maali in Lamia and Qaboos-nameh was to express educational and moral issues and spread and convey them to future generations. Ibn al-Wardi, like Onsur AL-maali, listed moral points such as knowledge, humility
... Show MoreBackground: One of the most prevalent procedures in oral surgery is the removal of impacted mandibular third molars, typically accompanied by trismus, edema, and pain. Several methods and biomaterials were implemented to mitigate or avoid these surgical problems. Objectives: To evaluate the efficiency of chlorhexidine gel (WISDOM®) in minimizing postoperative sequelae associated with the impacted mandibular third molar that will be surgically extracted and its role in promoting early soft tissue closure of the surgical site. Methods: The study design was a double-masked and randomized, controlled clinical study that included healthy patients needing the removal of a mandibular third molar through surgery. The participants were rand
... Show MoreIn the hybrid coolingsolar systems , a solar collectoris used to convertsolar energy intoheat sourcein order to super heat therefrigerant leave thecompressor,andthisprocess helpsin the transformation ofrefrigerant state from gaseous statetothe liquid statein upper two-thirdsof thecondenserinstead of the lower two-thirdssuchas in thetraditional air-conditioning systems and this willreduce theenergyneeded torun the process ofcooling.In this research two hybrid air-conditioning system with an evacuated tube solar collector were used, therefrigerant was R22 and the capacity was 2 tons each.The tilt angle of the evacuated tube solar collector was changed and the solar collector fluid was replaced into oil instead of water.A comparison wasi
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